D.C. Week: ACA Takes Full Effect

WASHINGTON -- Love it or hate it, the Affordable Care Act went into full swing this week as many of the law's provisions took effect at the start of 2014.

by David Pittman David Pittman Washington Correspondent, MedPage Today
January 04, 2014

WASHINGTON -- Love it or hate it, the Affordable Care Act (ACA) went into full swing this week as many of the law's provisions -- including the requirement that all individuals have health insurance coverage -- took effect at the start of 2014.

2.1 Million Enroll in Private ACA Coverage

More than six million individuals have enrolled in either Medicaid or private health plans sold under online exchanges or marketplaces since Oct. 1, the Obama administration said Tuesday.

The department made its arguments in response to an injunction granted to the Little Sisters of the Poor, a self-insured nonprofit organization that pays for its employees' health insurance.

The ACA mandate -- which took effect Jan. 1 -- says health plans must provide, without cost-sharing, coverage for preventive health services including birth control. But as a religious organization, the Little Sisters of the Poor can opt out of paying for birth control coverage by allowing a third-party administrator to be responsible for providing the coverage, something that the nuns objected to doing.

Report Clarifies Income Verification

Sebelius released a report Wednesday that certifies a consumer's income is confirmed before tax credits and other federal assistance are given to help purchase health insurance under the ACA. The report was required as part of the fiscal package that reopened the federal government after a nearly 3-week shutdown in October.

"As required by the Affordable Care Act and implementing regulations, when a consumer applies for insurance affordability programs, including advance payments of the premium tax credit and cost-sharing reductions, the Marketplace verifies application information provided by the consumer when making an eligibility determination," Sebelius wrote in a letter to Vice President Joe Biden and House Speaker John Boehner (R-Ohio).

The system helps prevent guns from being sold to individuals involuntarily committed to mental institutions, among other reasons for preventing a gun sale.

However, studies have shown states under-report individuals prohibited for mental health reasons, in part because of HIPAA concerns.

"There is a strong public safety need for this information to be accessible to the NICS, and some states are currently under-reporting or not reporting certain information to the NICS at all," Sebelius said in a statement.

According to a statement issued by Sanofi, "FDA has taken the position that Genzyme has not submitted evidence from adequate and well-controlled studies that demonstrate the benefits of Lemtrada outweigh its serious adverse effects."

The company said it strongly disagreed with the FDA's decision and vowed to appeal it. The European Union approved the drug in September. More recently, authorities in Australia and Canada followed suit.

The bonuses were authorized in the Children's Health Insurance Program (CHIP) Reauthorization Act of 2009. It is the fifth and final year of the bonuses.

States were rewarded for simplifying Medicaid and CHIP enrollment and renewal processes, with bonuses corresponding to the increase in children's Medicaid enrollment above a specific target.

Next Week

CMS on Monday will release its annual National Health Expenditures report for 2012.

On Thursday, the House Energy and Commerce Health Subcommittee will hold a hearing on Medicare extender policies -- which include payments for outpatient physical therapy and certain small-hospital programs.

On Friday, a three-judge panel of the U.S. Court of Appeals for the District of Columbia will hear a challenge to the ACA involving the Constitution's "origination clause." A ruling against the ACA could throw out the entire law.

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